2.0 Analysis 2.1 Condition of the Hull of the QASAOQ Coating a wooden hull with fibreglass takes experience and very specific knowledge. The wood must be dry, clean and free of any anomalies, or the fibreglass will not adhere to the hull. The QASAOQ had been beached at Iqaluit for two years unprotected from the weather, and this made proper drying of the hull difficult. It is imperative when performing hull renovation work that any parts in bad condition due to rot or damage be repaired or replaced before the fibreglass is applied. The surface of these parts must be carefully prepared before they are coated with fibreglass in order to ensure better adhesion. The techniques used in applying the fibreglass, the quality of the material, the tools used and the place where the work is done are all factors that must not be overlooked. The renovations to the QASAOQ were done outdoors, at times under adverse weather conditions for this kind of work. A marine type of fibreglass and resin is required to make repairs. Because the vessel sank, the quality of the fibreglass used could not be verified. 2.2 Vessel Inspection The Small Vessel Regulations apply to all pleasure craft not exceeding 20 tons permanently or temporarily equipped with a motor of 7.5 kW. The Regulations therefore applied to the QASAOQ which was considered a pleasure craft. Reportedly, no Iqaluit peace officer had examined the QASAOQ in the past 20 years, and such an examination was not required under the regulations. It is the responsibility of a vessel's owner to carry on board the safety equipment required by the Small Vessel Regulations. The Regulations do, however, provide that a peace officer may examine vessels at random to ensure that they comply with the regulatory requirements. 2.3 Radio Communications All communications between the vessel and the shore stations were conducted on the 5,210.00 kHz frequency, which is not a designated marine frequency. The radio used could not transmit on the designated marine distress frequency of 2,182 kHz and, therefore, could not be used to contact the Iqaluit CGRS. However, the frequency used for marine distress situations can easily be added to this type of radio by a technician. 2.4 Organization of SAR Operations in the Arctic Rapid response mechanisms have been put in place to ensure prompt and effective coverage in the event of a casualty. The RCC has to cover vast areas, and, as more than one SAR operation may be in progress at the same time, it is essential that the RCC be notified of occurrences as soon as practicable. Rapid deployment of resources is the key to success in SAR missions. The speedy relaying of information enables the RCC to organize and assemble additional resources in case they have to be deployed. The EMO apparently did not fully appreciate the need to notify the RCC immediately, since 1 hour and 13 minutes elapsed before the information was passed to the RCC. Fortunately in this case, the time taken to notify the RCC of the incident did not play any role in the outcome of the occurrence. As soon as a CGRS is informed of an incident that requires a SAR response, the radio operator must obtain the relevant information and notify the RCC as soon as practicable. In this case, although the CGRS had been notified of the incident, the radio operator did not obtain the relevant information or even contact the RCC; instead, he gave the telephone number of the RCC to the night dispatcher of the emergency service. The publication Radio Station: Operations Standards, 1992 (TP 989) sets out the procedure for the receipt of shipping casualty reports by CGRSs. Section 5.20.2, Chapter 2, of the publication states: In addition to acknowledging receipt of the distress message or other transmission indicating the existence of a distress situation, the Radio Operator shall obtain any information in addition to that contained in the distress message or equivalent which may aid in the rendering of assistance to the vessel in distress. Section 4.1.1 of the same chapter states in part that: A CGRS that becomes aware of a shipping casualty shall, as soon as practicable, notify the appropriate RCC/MRSC via SARCOM. The Iqaluit CGRS operator who received the distress notice over the telephone on 30 October did not comply with the operations standards. He did not obtain all the information concerning the nature of the distress call, nor did he notify the Halifax RCC. 3.0 Conclusions 3.1 Findings The keel, part of the transom and some garboards were rotted. The owner had performed the repair work on the hull himself. The quality of the fibreglass used for the repairs could not be verified. The QASAOQ had not been examined by a peace officer for some 20 years, and such an examination was not required under the regulations. The vessel was not carrying the life-saving equipment required for pleasure craft. The victims were not wearing lifejackets or personal flotation devices (PFD). No one aboard the QASAOQ could communicate with the Iqaluit Coast Guard Radio Station (CGRS) because the vessel's radiotelephone could not transmit on the designated marine frequencies. The CGRS operator did not ask for the details of the accident when he received the initial distress call. The methods of notification in effect unduly delayed the search and rescue (SAR) operation. A period of 1 hour and 13 minutes elapsed before the Emergency Measures Organization (EMO) alerted the authorities at the Halifax Rescue Coordination Centre (RCC). 3.2 Causes The condition of the hull of the QASAOQ, coupled with the sea and weather conditions, had a direct impact on the shipwreck. The fact that there was no life-saving equipment on board and that the occupants abandoned the vessel in a boat not designed to hold 10 persons reduced the victims' chances of survival. Furthermore, since no transmission could be made on the designated distress frequency from the vessel's radiotelephone, it was not possible to launch an early search and rescue operation. 4.0 Safety Action 4.1 Action Taken 4.1.1 Processing of Distress Messages Following this accident, personnel from the key agencies5 involved in search and rescue (SAR) operations in the North and representatives of Local Authorities met to review mandates and to discuss procedures relating to SAR operations. It was agreed that immediate notification of marine accidents must be made to the appropriate Rescue Coordination Centre (RCC) located at Trenton or Halifax. To avoid misunderstandings and delays, effective 01 April 1996, emergency dispatching and communications are handled by a dedicated Emergency Measures Organization (EMO) Centre. 4.1.2 Safety Information Program A series of four boating safety documentaries produced by the Canadian Coast Guard (CCG) for the Inuit was broadcast locally on community television. Furthermore, safety posters and copies of the Small Fishing Vessel: Safety Manual (TP 10038) in Inuktitut, containing a 1-800 information number, were distributed to local fishing communities.